Are remission and low disease activity state ideal targets for pregnancy planning in systemic lupus erythematosus? A multicentre study

Abstract

Objectives To determine whether disease remission or low disease activity state at the beginning of pregnancy in SLE patients is associated with better pregnancy outcome. Methods pregnancies in SLE patients prospectively monitored by pregnancy clinics at four rheumatology centres were enrolled. Patient demographics and clinical information were collected at baseline (pregnancy visit before 8 weeks of gestation) including whether patients were in remission according to DORIS criteria and and/or Lupus Low Disease Activity State (LLDAS). Univariate and multivariate analysis were performed to determine predictors of disease flare and adverse pregnancy outcomes (APOs) including preeclampsia, preterm delivery, small for gestational age infant, intrauterine growth restriction and intrauterine fetal death. Results 347 pregnancies were observed in 281 SLE patients. Excluding early pregnancy losses, 212 pregnancies (69.7%) occurred in patients who were in remission at baseline, 33 (10.9%) in patients in LLDAS, and the remainder in active patients. 73 flares (24%) were observed during pregnancy or puerperium, and 105 (34.5%) APOs occurred. Multivariate analysis revealed that patients in disease remission or taking hydroxychloroquine were less likely to have disease flare, while a history of lupus nephritis increased the risk. The risk of APOs was increased in patients with shorter disease duration, while being on hydroxychloroquine resulted a protective variable. An almost significant association between complete remission and a decreased risk of APOs was observed. Conclusions Prenatal planning with a firm treat-to-target goal of disease remission is an important strategy to reduce the risk of disease flares and severe obstetrical complications in SLE pregnancies.

Impact of low-dose acetylsalicylic acid on pregnancy outcome in systemic lupus erythematosus: results from a multicentre study

“…The first important result that emerged from this study is that the incidence of severe obstetric complications in this particular population is low; in particular, pre-eclampsia was observed in 6.1% of patients, an incidence significantly lower than that observed in unselected SLE cohorts and similar to the frequency observed in the general population 16–19. The incidence of pre-eclampsia in our cohort was also lower than that expected in high-risk pregnancies, where it is around 9% 20…”

Effectiveness of a multidisciplinary clinical pathway for women with systemic lupus erythematosus and/or antiphospholipid syndrome

“…6 11-14 Consequently, pregnancies in patients with SLE are nowadays more and more embraced, rather than discouraged, taking into account the challenges in the management of pregnant patients with SLE/APS. [15][16][17] This view is emphasised within the recently published Joint European League Against Rheumatism, European Renal Association and American College of Rheumatology (EULAR/ERA-EDTA/ACR) recommendations for the management of patients with SLE/APS with a pregnancy wish. [18][19][20] Within these recommendations, preconception counselling is considered essential.…”

Optimizing reproductive health management in lupus and Sjogren's syndrome

“…Fetal complications are also more common, including preterm birth, intrauterine fetal growth restriction and stillbirth [6 ▪▪ ,7,8,9 ▪ ,10]. Pulmonary hypertension and history of or active lupus nephritis at the time of conception are particularly strong risk factors for adverse maternal and fetal outcomes [11,12 ▪▪ ]. The presence of antiphospholipid antibodies (aPL) or syndrome (APS) also increase the risk of miscarriage and preeclampsia [4], and the presence of anti-Ro/SSA and/or anti-La/SSB antibodies increases the risk for neonatal lupus [1].…”